Prenatal Care

Prenatal care is the health care you receive from a doctor or a midwife while you are pregnant. These regular visits are essential to learn about how your pregnancy is progressing. Tests are performed to give you the peace of mind that your baby is healthy and determine if any treatment or precautions need to be considered. Studies show that babies of mothers who skip prenatal care are three times more likely to have low birth weight and five times more likely to die than mothers who receive recommended care.

Most experts suggest that you visit your doctor about once a month for weeks 4 through 28, twice a month for weeks 28 through 36, and weekly for weeks 36 to birth.

Health care do’s:

Ask your doctor about the right amount and intensity of workouts.

Ask your doctor before starting or stopping any prescription or over-the-counter medicines or herbal products.

Eat a variety of healthy foods and drink plenty of fluids.

Get a flu shot.

Get a pertussis vaccine.

Get early and regular prenatal care.

Get plenty of sleep.

If you have a cat, ask your doctor about toxoplasmosis, an infection caused by a parasite sometimes found in cat feces.

Protect yourself and your baby from food-borne illnesses, including toxoplasmosis and listeria.

Talk to your health care provider about an exercise regimen.

Take a multivitamin with 400 to 800 micrograms of folic acid every day.

What Is Prenatal or Antenatal Testing?

Your health care provider may perform certain tests during your pregnancy to make sure that you and your baby are doing well. These tests can alert you and your doctor to possible complications and identify possible birth defects.

quad screen, usually done during the second trimester, to evaluate risk of chromosomal abnormalities, abdominal wall defects, or neural tube defects

ultrasound to confirm gestational age and check your baby’s health, growth, and development

Stages of Pregnancy

Pregnancy is an amazing 40-week journey that is divided into three trimesters, each about three months long. The clock starts on the first day of your last menstrual period even though conception hasn’t even occurred yet. That happens about two weeks later when you ovulate and the egg is fertilized. The process of baby development begins as the fertilized egg implants onto your uterine wall and the embryo starts growing. Conception causes the release of a hormone called human chorionic gonadotrophin (hCG), which can be detected by home pregnancy tests around three to four weeks from the first day of your last period. At conception, the baby’s complete genetic makeup and sex are already determined.

1st Trimester (Weeks 1-12)

You

Pregnancy brings profound changes to your body. There are immediate changes in the levels of several hormones producing symptoms that include:

acne

constipation

fatigue

food cravings or distaste for certain foods

headaches

heartburn

increased urge to urinate

mood swings

morning sickness characterized by nausea and vomiting

skin and hair changes

tender, swollen breasts

weight changes

To alleviate some of these symptoms, you might need to change your daily activities. Try going to bed earlier and eat smaller meals more frequently. Fortunately, some of these symptoms will go away as you enter your second trimester.

Your Baby

The first trimester is the most sensitive time for baby’s development. Up to the eighth week of pregnancy, your developing baby is called an embryo. From that time on until birth, your developing baby is called a fetus.

At the end of the first month, your baby is about the size of a pea but her arms, legs, and vital organs like her heart, lungs, and brain have started to form. Her face develops with large dark circles for eyes. At about six weeks, your baby’s heartbeat can be detected.

By the end of the second month, fingers, wrists, ankles, and genitals begin to form and your baby grows to the size of a kidney bean. The digestive tract and sensory organs also begin to develop.

In the third month, bones and muscles start growing. By the end of the third month, all organs and extremities are present.

Second trimester (weeks 13-27)

You

By the second trimester, your body has generally adjusted to hormonal changes and many symptoms of early pregnancy like nausea and fatigue diminish or disappear. Your chances of miscarriage also drop significantly. However, some new symptoms may appear:

a line from your belly button to pubic hairline may become visible

belly itch due to skin tightening

darkening or enlargement of the areolas

more pelvic pressure and experience backaches

darker patches of skin on the face

stretch marks

swelling of the ankles, finger, and face

Your Baby

In the fourth month of pregnancy, your baby’s heartbeat may be audible with a doppler. Her fingers and toes become defined and eyelids, eyebrows, eyelashes, nails, and hair are formed. Your baby can suck her thumb, yawn, stretch, and make faces.

In the fifth month, your baby becomes more active and you may be able to feel her movements.

By week 14, your baby may start to breathe. After 18 weeks, an ultrasound can reveal your baby’s gender and she may even develop a regular sleep/wake cycle. By the end of the sixth month, your baby is about 12 inches long and weighs about 2 pounds. After week 23, your baby may survive with intensive care, if born prematurely.

Third trimester (weeks 28-40)

You

During the third trimester, you might experience the following:

breasts may start leaking as they prepare for breastfeeding

increased pressure on the bladder increases your urge to urinate

retention of fluids causes swollen extremities

shortness of breath because your lungs have less room to expand

trouble sleeping due to your growing baby bump

varicose veins may make an unwelcome appearance

You may also experience painless, irregular contractions, called Braxton-Hicks contractions, or false labor, which is the result of the tightening of the uterus.

In the ninth month, you may experience a vaginal discharge containing mucus and a bit of blood, called the bloody show, which may increase signifying the very beginning of labor. While these last weeks may be the most uncomfortable period, your will feel excited for what is soon to come!

Your Baby

By the seventh month of pregnancy, your baby can open and close her eyes, change positions, and respond to light and sound. At the end of the seventh month, your baby is about 14 inches long and weighs 2 to 4 pounds.

During the eighth month of pregnancy, your baby will gain weight quickly and her brain will develop rapidly. In the ninth month, your baby’s reflexes become coordinated and lungs become fully formed. She gets ready for birth by turning into a head-down position in your pelvis. This is called lightening. After your baby drops down to this position, birth can occur at any time.

Cari Nierenberg. Having a Baby | Stages of Pregnancy, Live Science Contributor. March 31, 2015.

Labor & Delivery

The wait is finally over and it is time to bring your baby into this world. The due date doctor provided you can be off a bit but there are some tell-tale signs that labor is about to begin.

Lightening. Your baby’s head drops down into the pelvic region to prepare for delivery. Your baby bump may look lower and your breathing may improve as your baby moves away from the lungs. However, your urge to urinate increases even more as your baby presses against the bladder. Lightening can occur a few weeks to a few hours before the onset of labor.

Diarrhea. Frequent loose stools may be a precursor to labor.

Bloody show. You notice a slightly bloody or brownish discharge.

Contractions that occur at intervals of less than 10 minutes and become progressively more frequent.

Water breaks. Fluid leaking occurs as the amniotic sac is broken. Most women go into labor within 24 hours.

Stages of Labor

The time spent in each stage of delivery varies. If this is your first pregnancy, it usually lasts about 12 to 14 hours. It becomes shorter for subsequent pregnancies. Labor is typically divided into three stages:

Stage 1 can be divided into three phases:

Latent phase is the longest and can last one to two days. During this phase, your cervix will begin to open (dilate) and thin out (efface) and contractions would become more and more frequent. When your contractions are regular and strong, and coming every four to five minutes for one to two hours, you should call your midwife or doctor. Call the doctor right away if:

Your discharge becomes bright red

When your water breaks, the amniotic fluid is greenish

You don’t feel any fetal activity

During the active phase, the cervix begins to dilate more rapidly and you get examined regularly to assess how labor is progressing. You may feel intense pain during each contraction and you won’t be able to talk through them. Many women ask for pain relief (see pain management for options). On average, your cervix will dilate about one centimeter per hour.

Last part of active labor is called transition when the cervix fully dilates to 10 centimeters. Contractions come almost every three minutes and last for about a minute. They can be strong and painful. You may also feel the urge to push down, but your provider will ask you to wait until your cervix is completely open. This is the time to use the breathing and relaxation exercises you learned from the expectant parent classes. You will need support from your partner. Don’t be shy about asking for help whether it is a back rub or a wet washcloth to put on your face. You may feel very warm and sweaty and feel strong pressure in the lower back.

Stage 2— Delivery

Vaginal Delivery

Delivery stage begins when the cervix is completely effaced or open. Now is the time to push which will help move your baby through the birth canal. You may want to try different positions like kneeling, squatting, or sitting to see what feels most comfortable. When your baby’s head becomes visible and stays visible without slipping back in, it is called crowning. Once your baby is delivered, your doctor or your partner clamps and cuts the umbilical cord. You will be advised to not have sex for 6 weeks.

Water Birth

A water birth means at least part of your labor and/or delivery takes place in a temperature-regulated warm tub of water. The idea behind water birth is that it would be gentler for the baby to come into this world in water which would be a more familiar environment for her since she has been swimming in amniotic fluid all her life. Being in water during the first stage of labor may have some benefits like easing pain, reducing the need for anesthesia, and speeding labor. Warm water may help you relax and move more easily. However, delivery under water comes with some risks. Usually, water births are for mothers who do not need to be monitored closely. Talk to your provider to see if a water birth is an option for you.

Delivery by Cesarean

A cesarean section, or C-section, is a surgical procedure to deliver your baby by making an incision in your abdomen and uterus. It can be pre-planned or performed urgently to protect the health of the mother or the baby. The rate of cesarean sections has grown by more than 50% in the last decade to account for about a third of all births in the U.S. A typical cesarean section lasts about 3-4 hours.

The advantages of a cesarean section include knowing precisely when your baby is going to be born and having a team of medical professionals present to address any complications. However, it is major surgery which can damage surrounding organs or cause an infection. It will prolong your hospital stay to about 3 days versus two days for a vaginal birth. You will be advised not to lift much more than your baby or drive for a couple of weeks and refrain from exercise or sex for six weeks.

Stage 3

In this stage, the placenta, which provided nourishment to your baby in the womb, is delivered. It usually takes 20 to 30 minutes after birth. Your provider will examine you and stitch any tears.

Pain Management

Labor and delivery is a lot of work and is painful. Fortunately, there are many ways to manage the pain. Since you now have more control over your birthing experience than ever before, you can choose several methods to help get through your pain.

Without Medication:

Breathing techniques

Massages

Moving around

Relaxation techniques

With Medication:

Minimal intervention pain management — Nitrous oxide, sometimes referred to as laughing gas, is a decades old proven method to manage pain during labor. It allows you to have control over how much pain relief you need and when you need it.

IV pain medication — You can choose IV pain medication to dull your pain, which will not interfere with the progression of labor or your ability to push during delivery.

Epidural — You can have peace of mind that if you need more pain control, you can get an epidural with virtually no waiting. Epidurals block the pain almost instantly. At hospitals, more than half of the women giving births choose epidural anesthesia.

Breastfeeding

Breastfeeding is one of the greatest gifts you can give to your baby and the baby can give you. Your breast milk is the ideal mix of proteins, vitamins, and fat for your baby which bolsters immunity against infections, reduces risk of getting asthma and allergies, helps in digestion, and promotes brain development. And for you the mother, it is a great away to get rid of those extra pounds gained during pregnancy, restores uterus to its original size, and reduce your risk for osteoporosis, heart disease, high blood pressure, and breast, and ovarian cancer in your lifetime.

And the bonding experience is invaluable.

But there can be challenges in the crucial first week when you and the baby are trying to figure things out and milk supply is established. There may be resignation and feelings of inadequacy that, “I can’t get this right” and painful breasts and sore nipples. But it will work out. It almost always does.

Things to remember:

Women have been breastfeeding babies since the beginning of time.

There will be some trial and error to find a comfortable position.

Don’t panic. Your baby will not starve. She was born with energy reserves to get through this period.

It is good to know that a baby’s first meal from a mother is not milk, it’s colostrum, a yellowish liquid rich in antibodies that boosts your baby’s immune system and helps digestive tract develop. Milk starts flowing in a few days after you give birth.

There are several positions to breastfeed but the easiest at this point is to sit up straight in the hospital bed or armchair, put a pillow across your lap to bring the baby up to the level of your breast and place pillows to support your arms and back to be in a comfortable position. Make sure your baby is placed skin to skin, tummy to tummy to easily contact all of the nipple and majority of your areola. If your baby isn’t latched on correctly and nursing with a smooth, comfortable rhythm, gently nudge your pinky into the corner of baby’s mouth to break the suction, remove your nipple, and try again.

Other common positions are:

Cradle Position – Lay baby lengthwise across your abdomen, her head will rest in the crook of your elbow. Use your free hand to assist her to get latched on.

Cross Cradle Position – This position differs from the cradle hold in that your baby’s head does not rest in the crook of your elbow. Instead, you will use the arm on the same side as the breast you are feeding on to control the breast and assist with latch. The opposite arm will rest along your baby’s back while the hand supports and controls her head. This position is often most helpful early on.

Football Position – Tuck your baby under your arm on the same side you will be nursing from. Her nose should be level with your nipple. Rest your arm on a pillow for support. Use your hand to support her shoulders, neck, and head. Use your free hand to assist with latch.

Side-Lying Position – With you being on your side, lay your baby on her side, tummy to tummy next to you in bed. Bring her mouth toward the nipple closest to the bed and put your other arm around her.

Feeding:

For the first few weeks, your baby should be fed every two to three hours for 8-12 feedings daily. Each nursing session could last 20-45 minutes on each breast. It is fine to break the latch if your baby has been on one breast for too long. Feeding time decreases as your baby gets better at sucking and milk production increases.

You will develop an awareness of when your baby is hungry. Babies move their hands toward their mouths, make sucking noises or mouth movements, or move toward your breast to tell you it is feeding time. Babies will also cry if they are too hungry.

Try not to introduce the bottle for about a month because it is easier for your baby to get milk from an artificial nipple and it may be difficult to get her to return to feeding at your breast. Experts recommend exclusive breastfeeding for the first six months (no formula, juice, cereal, or water) and continued breastfeeding for at least one year.

It may take several weeks for your milk-production system to regulate itself and stop leaking and spraying. Drink a large glass of water every time you nurse and remember to take your vitamins.

Seek help early from Quinn Jacobs, RN and Glacial Ridge Hospital lactation consultant, to get your questions answered to have peace of mind. Call 320.634.4521 Monday through Friday.

Helpful Items:

Breast massage – It is very important to use your hands to massage your breasts during feedings to aid in transferring colostrum to your baby early on. Colostrum does not flow easily like mature milk does. Your baby will get more colostrum at each feeding and will be more satisfied after feedings if you massage breasts during your feedings.

Hands on pumping – If you need to use a breast pump to remove your colostrum or milk, it is important to use your hands to massage your breasts throughout the pumping session to maximize the amount of colostrum or milk you are able to get out. The more milk you are able to remove, the more milk you will make.

Breast Pump – Used to express milk for storage, relieve engorgement, or stimulate lactation for women with low milk supply. Breast milk can be safely used within two days if it’s stored in a refrigerator. You can freeze breast milk for up to six months.

Nursing pillow – Specially designed pillows can help you position your baby correctly and help you be comfortable

Nursing bra – It provides support and you don’t have to undress every time you breastfeed. Avoid underwire bras. The wire can put pressure on your milk duct and interfere with milk production.

Refrigerator. Freshly expressed breast milk can be stored in the back of the refrigerator for up to five days. It is advised that the milk is transferred to a freezer within three days if it is going to be stored for a longer period.

Deep freezer. Freshly expressed breast milk can be stored in the back of a deep freezer for up to 12 months, however, usage within six months is advised.

It is important to know that storage guidelines might be different for preterm, sick, or hospitalized infants.

Use the oldest milk first. Don’t use a microwave or high heat to thaw milk. It can burn your baby’s mouth and also degrade antibodies. Place frozen milk overnight in the refrigerator. Gently warm the milk in warm water.